Assessing Advancing our Culture of Quality Improvement Objectives

Assessing & Advancing our Culture of Quality Improvement

Objectives • Provide a brief overview of quality improvement (QI) concepts • Introduce the NACCHO Roadmap to a Culture of Quality and QI Self-Assessment Tool • Describe the 6 foundational elements of a culture of QI • Describe staff roles in cultivating a QI culture • Outline a process for assessing our QI culture • Administer the QI self-assessment through facilitated discussion and group scoring

Quality Improvement Overview

What is Quality Improvement? Quality Improvement in Public Health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community. Source: Riley, Moran, Corso, Beitsch, Bialek, and Cofsky. Defining Quality Improvement in Public Health. Journal of Public Health Management and Practice. January/February 2010

What is Quality Improvement? “Every system is perfectly designed to achieve the results it gets. ” ~ W. Edwards Deming

What is a Culture of Quality Improvement? • Continuous improvement vs. status quo • Intrinsic motivation vs. extrinsic motivation • Data driven decision making • Collaborative vs. siloed • Customer focus • Innovation is the norm • Describe the agency vision for QI

Roadmap to a Culture of Quality Phase 1: No Knowledge of QI Phase 2: Not Involved with QI Phase 3: Informal or Ad Hoc QI Phase 4: Formal QI in Specific Areas Phase 5: Formal Agency. Wide QI www. qiroadmap. org Phase 6: Quality Culture

Six foundational elements to a culture of QI Staff Empowerment Continuous Process Improvement Teamwork & Collaboration Quality Culture QI Infrastructure Leadership Commitment Customer Focus

The Foundational Elements of a QI Culture

Foundational Element 1: Staff Empowerment Staff are empowered to use QI in their daily work through: • • • Trainings, coaches, and resources Clear expectations Opportunities to implement QI Autonomy to make improvements Performance feedback systems List workforce development efforts and employee feedback systems.

Foundational Element 2: Teamwork and Collaboration Create effective team performance by: • Defining team expectations • Carefully selecting team members • Holding teams accountable Break down silos through: • Communication of lessons learned • Formal/informal learning and problem solving groups • Eliminating redundancies and creating alignment • List opportunities for collaboration in the agency.

Foundational Element 3: Leadership Commitment • Dedicate financial and human resources to QI • Communicate the vision and urgency for QI • Empower staff to engage in QI • Hold staff accountable • Exhibit visible support for QI • Add leadership commitment to date (e. g. dedicated resources, $$, QI committee) • Add leadership expectations of staff

Foundational Element 4: Customer Focus • A customer focus is part of the agency’s core values and vision • Data on customer satisfaction and needs • Customer data drives decision making and improvement efforts • Employees are empowered to exceed customer expectations • Add current efforts to collect and use customer data. • Add next steps for establishing customer data collection mechanisms agency-wide.

Foundational Element 5: QI Infrastructure Alignment of QI with organization’s • Mission • Vision • Strategic direction • Performance Three key components of a strong QI infrastructure • QI governing body • Performance Management System • QI Plan

Foundational Element 5: QI Infrastructure (QI Governance) • Insert name of agency QI governing body • Insert names/titles of the members • Insert accomplishments, roles, and/or current initiatives

Foundational Element 5: QI Infrastructure (PM System) • • Aligns with agency strategic direction Provides a foundation for decision making Helps identify improvement opportunities Provides meaningful feedback to employees

Foundational Element 5: QI Infrastructure (PM System) • Add information about your current PM system, including screenshots if available • If you have a PM Committee, identify members • Identify next steps for PM at the agency

Foundational Element 5: QI Infrastructure (QI Plan) • Add Screenshot of your QI plan, if available, or add some notes about the current status of your QI plan • List major QI activities outlined in the QI plan • Identify where staff can access the QI plan

Foundational Element 6: Continuous Process Improvement • Also called Continuous Quality Improvement (CQI) • Common methods are Lean, Six Sigma, and Business Process Re-engineering, or Plan-Do. Check-Act (PDCA) or Plan-Do-Study-Act (PDSA) cycles. • Elaborate on health department’s QI process here • Add how staff can nominate or get engaged with QI projects.

Foundational Element 6: Continuous Process Improvement • Insert example QI project(s) at health department

Staff Roles in Implementing Quality Improvement

Staff roles in creating a QI culture: Senior Leadership • Communicating a vision for QI • Creating a culture where employees feel safe taking risks without fear of reprimand • Allocating time and resources for QI • Providing oversight to make sure QI planning and assessment are done on a regular basis

Staff roles in creating a QI culture: Managers & Supervisors • Offering staff time to participate in QI trainings • Giving staff time to work on QI projects • Encouraging staff to speak up when they see potential for improvement in a process • Undergoing QI training themselves to ensure understanding of QI principles • Other roles of managers and supervisors in facilitating QI?

Staff roles in creating a QI culture: QI Leaders • Define the QI vision for staff • Incorporate quality into policies, plans, procedures, and culture • Provide ongoing QI training opportunities, mentoring and coaching • Address questions and concerns about quality improvement • Add QI staff names and roles here or on new slide, if not already covered under QI/PM council

Staff roles in creating a QI culture: Frontline, program, and admin staff • Collaborate across divisions and programs to share knowledge • Participate in QI training opportunities • Be open to trying new ways to improve processes • Suggest QI project ideas and participate on QI project teams • Ask questions, utilize mentorship and coaching • Other ideas?

Assessing our QI Culture

Organizational Culture of Quality Self-Assessment Tool (SAT) • • • Comprehensive assessment Based on the 6 foundational elements (20 sub-elements) Aligned with QI Roadmap Links results with transition strategies Scoring Summary Sheet

Interpreting the SAT Assessment Scale Roadmap Phase 1: No knowledge or awareness of QI Phase 2: Not Involved in QI Activities Phase 3: Informal or Ad Hoc QI Phase 4: Formal QI in Specific Areas of the Agency Phase 5: Formal Agency-wide QI Phase 6: QI Culture SAT Scale Interpretation Rating 1 A rating of ‘ 1’ indicates that the respondent strongly disagrees that the statement applies to the agency and/or has no knowledge or awareness of whether the statement applies 2 A rating of ‘ 2’ indicates that the respondent disagrees that the statement applies to the agency. 3 4 5 6 A rating of ‘ 3’ indicates that the respondent feels the statement applies to the agency inconsistently or on an informal or ad hoc basis. A rating of ‘ 4’ indicates that the respondent agrees the statement consistently applies to some areas of the agency, but is not agency-wide. A rating of ‘ 5’ indicates that the respondent agrees the statement consistently applies agency-wide A rating of ‘ 6’ indicates that the respondent strongly agrees that the idea referenced in the statement is fully integrated into the agency culture.

QI Assessment & Planning Process • • • QI/PM council is responsible for QI assessment and planning QI assessment conducted every 1 -3 years Move through QI Roadmap phase by phase. Sustain the progress made in each phase. Update the QI plan each year after QI assessment is conducted.

QI Self-Assessment Process: Next Steps [Adapt this slide according to your QI assessment process]. 1. Staff complete [online/paper] assessment by DATE 2. QI Committee will average the scores for each foundational element/sub-element and calculate an overall score by DATE 3. QI Committee will prioritize strategies for addressing QI gaps DATE 4. Strategies are selected and prioritized by DATE 5. Strategies are incorporated into QI plan and presented to staff by DATE

THANK YOU! Questions?